Abstract
Purpose
Occupational harmful factors, such as shift work, are attracting increasing attention as a potential cause of nonalcoholic fatty liver disease (NAFLD). In this study, we aimed to identify the association between shift work and NAFLD incidence in Chinese rail population.
Methods
A cohort study was conducted among 14,112 rail workers for 4-year follow-up. Shift work frequency and other potential variables were recorded by questionnaires, including demographic, lifestyle, and occupation information. Besides, body mass index, blood pressure, fasting blood glucose, total cholesterol, triglyceride, alanine aminotransferase, and aspartate aminotransferase were measured by anthropometric measurement and blood test. Diagnosis of new NAFLD case was based on abdominal ultrasonography. Cox proportional hazards regression model was used to determine whether shift work has effect on occurrence of NAFLD.
Results
The incidence of NAFLD was 30.43% in total subjects. After adjustment for possible confounders, the RRs of NAFLD were 1.069 (95% CI 0.998–1.146) and 1.179 (95% CI 1.059–1.312) in occasionally shift work group and frequently shift work group respectively, compared to the seldom shift work group. In stratified analyses, the RRs of NAFLD incidence linked to shift work exposure seems increase among female and elder. The results of three sensitivity analyses were similar with main analysis.
Conclusions
This research provided further evidence of positive harmful effect of shift work on NAFLD incidence in Chinese rail workers, particularly in frequently shift work population. The risk estimate of shift work on NAFLD was higher in female and elder.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and materials
The data that support the findings of this study are available from the corresponding author, Professor Nai-jun Tang, upon reasonable request.
References
Bailey SM (2018) Emerging role of circadian clock disruption in alcohol-induced liver disease. Am J Physiol Gastrointest Liver Physiol 315(3):G364–G373. https://doi.org/10.1152/ajpgi.00010.2018
Balakrishnan M, El-Serag HB, Kanwal F, Thrift AP (2017) Shiftwork is not associated with increased risk of NAFLD: findings from the National Health and Nutrition Examination Survey. Dig Dis Sci 62(2):526–533. https://doi.org/10.1007/s10620-016-4401-1
Bao H-W-S (2022) bruceR: Broadly useful convenient and efficient R functions. R package version 0.8.x. https://CRAN.R-project.org/package=bruceR
Bayrak M (2020) Non-invasive diagnosis of nonalcoholic fatty liver disease: impact of age and other risk factors. Aging Male 23(5):1275–1282. https://doi.org/10.1080/13685538.2020.1763293
Bhatt SP, Misra A, Nigam P (2019) Nutrition and physical activity in Asian Indians with non-alcoholic fatty liver: a case control study. Diabetes Metab Syndr 13(2):1271–1274. https://doi.org/10.1016/j.dsx.2019.01.054
Casey T et al (2021) Transcriptome analysis reveals disruption of circadian rhythms in late gestation dairy cows may increase risk for fatty liver and reduced mammary remodeling. Physiol Genom 53(11):441–455. https://doi.org/10.1152/physiolgenomics.00028.2021
Chappel SE, Aisbett B, Considine J, Ridgers ND (2021) Bidirectional associations between emergency nurses’ occupational and leisure physical activity: an observational study. J Sports Sci 39(6):705–713. https://doi.org/10.1080/02640414.2020.1841921
Chin SH, Kahathuduwa CN, Binks M (2016) Physical activity and obesity: what we know and what we need to know. Obes Rev 17(12):1226–1244. https://doi.org/10.1111/obr.12460
Choi H et al (2019) Relationship between shift work and liver enzymes: a cross-sectional study based on the Korea National Health and Examination Survey (2007–2015). Ann Occup Environ Med 31:e15. https://doi.org/10.35371/aoem.2019.31.e15
De Bacquer D, Van Risseghem M, Clays E, Kittel F, De Backer G, Braeckman L (2009) Rotating shift work and the metabolic syndrome: a prospective study. Int J Epidemiol 38(3):848–854. https://doi.org/10.1093/ije/dyn360
Dong C, Zeng H, Yang B, Zhang Y, Li Z (2022) The association between long-term night shift work and metabolic syndrome: a cross-sectional study of male railway workers in southwest China. BMC Cardiovasc Disord 22(1):263. https://doi.org/10.1186/s12872-022-02705-7
Elagizi A, Kachur S, Carbone S, Lavie CJ, Blair SN (2020) A review of obesity, physical activity, and cardiovascular disease. Curr Obes Rep 9(4):571–581. https://doi.org/10.1007/s13679-020-00403-z
Filipski E, Subramanian P, Carriere J, Guettier C, Barbason H, Levi F (2009) Circadian disruption accelerates liver carcinogenesis in mice. Mutat Res 680(1–2):95–105. https://doi.org/10.1016/j.mrgentox.2009.10.002
Gan L, Chitturi S, Farrell GC (2011) Mechanisms and implications of age-related changes in the liver: nonalcoholic Fatty liver disease in the elderly. Curr Gerontol Geriatr Res 2011:831536. https://doi.org/10.1155/2011/831536
Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A (2017) Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol 23(17):3150–3162. https://doi.org/10.3748/wjg.v23.i17.3150
Guo B et al (2021) Exposure to air pollution is associated with an increased risk of metabolic dysfunction-associated fatty liver disease. J Hepatol 76(3):518–525. https://doi.org/10.1016/j.jhep.2021.10.016
Imaizumi H et al (2015) The association between sleep duration and non-alcoholic fatty liver disease among Japanese men and women. Obes Facts 8(4):234–242. https://doi.org/10.1159/000436997
Ji Y, Elkin K, Yip J, Guan L, Han W, Ding Y (2019) From circadian clocks to non-alcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol 13(11):1107–1112. https://doi.org/10.1080/17474124.2019.1684899
Joshi A, Upadhyay KK, Vohra A, Shirsath K, Devkar R (2021) Melatonin induces Nrf2-HO-1 reprogramming and corrections in hepatic core clock oscillations in non-alcoholic fatty liver disease. FASEB J 35(9):e21803. https://doi.org/10.1096/fj.202002556RRR
Jung HS et al (2019) Smoking and the risk of non-alcoholic fatty liver disease: a cohort study. Am J Gastroenterol 114(3):453–463. https://doi.org/10.1038/s41395-018-0283-5
Kang D et al (2020) Perceived stress and non-alcoholic fatty liver disease in apparently healthy men and women. Sci Rep 10(1):38. https://doi.org/10.1038/s41598-019-57036-z
Khosravipour M, Shah Mohammadi M (2020) The effects of exposure to night shift work on liver function: a cross-sectional study with emphasis of alkaline phosphatase enzyme. Chronobiol Int 37(1):142–145. https://doi.org/10.1080/07420528.2019.1684936
Khosravipour M, Khanlari P, Khazaie S, Khosravipour H, Khazaie H (2021) A systematic review and meta-analysis of the association between shift work and metabolic syndrome: the roles of sleep, gender, and type of shift work. Sleep Med Rev 57:101427. https://doi.org/10.1016/j.smrv.2021.101427
Kim HJ et al (2016) Gender-based differences in the relationship between fatty liver disease and atherosclerosis. Cardiovasc J Afr 27(5):281–286. https://doi.org/10.5830/CVJA-2016-014
Kim D, Vazquez-Montesino LM, Li AA, Cholankeril G, Ahmed A (2020) Inadequate physical activity and sedentary behavior are independent predictors of nonalcoholic fatty liver disease. Hepatology 72(5):1556–1568. https://doi.org/10.1002/hep.31158
Kim D et al (2021) Physical activity, measured objectively, is associated with lower mortality in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 19(6):1240-1247.e5. https://doi.org/10.1016/j.cgh.2020.07.023
Kogevinas M et al (2019) Prostate cancer risk decreases following cessation of night shift work. Int J Cancer 145(9):2597–2599. https://doi.org/10.1002/ijc.32528
Konturek PC, Brzozowski T, Konturek SJ (2011) Gut clock: implication of circadian rhythms in the gastrointestinal tract. J Physiol Pharmacol 62(2):139–150
Li Z, Xue J, Chen P, Chen L, Yan S, Liu L (2014) Prevalence of nonalcoholic fatty liver disease in mainland of China: a meta-analysis of published studies. J Gastroenterol Hepatol 29(1):42–51. https://doi.org/10.1111/jgh.12428
Lin YC, Hsieh IC, Chen PC (2014) Long-term day-and-night rotating shift work poses a barrier to the normalization of alanine transaminase. Chronobiol Int 31(4):487–495. https://doi.org/10.3109/07420528.2013.872120
Loeffelholz CV, Roth J, Coldewey SM, Birkenfeld AL (2021) The role of physical activity in nonalcoholic and metabolic dysfunction associated fatty liver disease. Biomedicines 9(12):1853. https://doi.org/10.3390/biomedicines9121853
Manouchehri E, Taghipour A, Ghavami V, Ebadi A, Homaei F, Latifnejad Roudsari R (2021) Night-shift work duration and breast cancer risk: an updated systematic review and meta-analysis. BMC Womens Health 21(1):89. https://doi.org/10.1186/s12905-021-01233-4
Marchesini G, Petta S, Dalle Grave R (2016) Diet, weight loss, and liver health in nonalcoholic fatty liver disease: pathophysiology, evidence, and practice. Hepatology 63(6):2032–2043. https://doi.org/10.1002/hep.28392
Martin C et al (2003) Effect of age and photoperiodic conditions on metabolism and oxidative stress related markers at different circadian stages in rat liver and kidney. Life Sci 73(3):327–335. https://doi.org/10.1016/s0024-3205(03)00271-6
Mayama M, Umazume T, Watari H, Nishiguchi S, Moromizato T, Watari T (2020) Frequency of night shift and menstrual cycle characteristics in Japanese nurses working under two or three rotating shifts. J Occup Health 62(1):e12180. https://doi.org/10.1002/1348-9585.12180
Meroni M, Longo M, Rustichelli A, Dongiovanni P (2020) Nutrition and genetics in NAFLD: the perfect binomium. Int J Mol Sci 21(8):2986. https://doi.org/10.3390/ijms21082986
Mostafavi SA et al (2017) Role of melatonin in body weight: a systematic review and meta-analysis. Curr Pharm Des 23(23):3445–3452. https://doi.org/10.2174/1381612822666161129145618
Murata K, Nogawa K, Suwazono Y (2013) The relationship between job type and development of cerebral stroke in a large, longitudinal cohort study of workers in a railway company in Japan. Atherosclerosis 229(1):217–221. https://doi.org/10.1016/j.atherosclerosis.2013.04.013
Ni L, Yu D, Wu T, Jin F (2021) Gender-specific association between non-alcoholic fatty liver disease and type 2 diabetes mellitus among a middle-aged and elderly Chinese population: an observational study. Medicine (baltimore) 100(6):e24743. https://doi.org/10.1097/MD.0000000000024743
Noureddin M et al (2020) Diet associations with nonalcoholic fatty liver disease in an ethnically diverse population: the multiethnic cohort. Hepatology 71(6):1940–1952. https://doi.org/10.1002/hep.30967
Orci LA, Gariani K, Oldani G, Delaune V, Morel P, Toso C (2016) Exercise-based interventions for nonalcoholic fatty liver disease: a meta-analysis and meta-regression. Clin Gastroenterol Hepatol 14(10):1398–1411. https://doi.org/10.1016/j.cgh.2016.04.036
Palacios-Jordan H et al (2020) The disruption of liver metabolic circadian rhythms by a cafeteria diet is sex-dependent in Fischer 344 rats. Nutrients 12(4):1085. https://doi.org/10.3390/nu12041085
Pan JJ, Fallon MB (2014) Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol 6(5):274–283. https://doi.org/10.4254/wjh.v6.i5.274
Salgado-Delgado RC, Saderi N, Basualdo Mdel C, Guerrero-Vargas NN, Escobar C, Buijs RM (2013) Shift work or food intake during the rest phase promotes metabolic disruption and desynchrony of liver genes in male rats. PLoS ONE 8(4):e60052. https://doi.org/10.1371/journal.pone.0060052
Schwimmer JB et al (2019) Effect of a low free sugar diet vs usual diet on nonalcoholic fatty liver disease in adolescent boys: a randomized clinical trial. JAMA 321(3):256–265. https://doi.org/10.1001/jama.2018.20579
Shea S et al (2021) Non-alcoholic fatty liver disease (NAFLD) and potential links to depression, anxiety, and chronic stress. Biomedicines 9(11):1697. https://doi.org/10.3390/biomedicines9111697
Shen X et al (2019) Prospective study of perceived dietary salt intake and the risk of non-alcoholic fatty liver disease. J Hum Nutr Diet 32(6):802–809. https://doi.org/10.1111/jhn.12674
Shima T et al (2015) Influence of lifestyle-related diseases and age on the development and progression of non-alcoholic fatty liver disease. Hepatol Res 45(5):548–559. https://doi.org/10.1111/hepr.12384
Shin MG, Kim YJ, Kim TK, Kang D (2021) Effects of long working hours and night work on subjective well-being depending on work creativity and task variety, and occupation: the role of working-time mismatch, variability, shift work, and autonomy. Int J Environ Res Public Health 18(12):6371. https://doi.org/10.3390/ijerph18126371
Sohrabi M et al (2021) melatonin levels in patients with nonalcoholic fatty liver disease compared with healthy individuals according to fibrosis level. Middle East J Dig Dis 13(2):109–114. https://doi.org/10.34172/mejdd.2021.213
Sørensen M, Ketzel M, Overvad K, Tjønneland A, Raaschou-Nielsen O (2014) Exposure to road traffic and railway noise and postmenopausal breast cancer: a cohort study. Int J Cancer 134(11):2691–2698. https://doi.org/10.1002/ijc.28592
Stimson RH et al (2017) Acute physiological effects of glucocorticoids on fuel metabolism in humans are permissive but not direct. Diabetes Obes Metab 19(6):883–891. https://doi.org/10.1111/dom.12899
Sung KC, Lee MY, Lee JY, Lee SH, Kim SH, Kim SH (2019) Utility of ALT concentration in men and women with nonalcoholic fatty liver disease: cohort study. J Clin Med 8(4):445. https://doi.org/10.3390/jcm8040445
Tarantino G, Capone D, Finelli C (2013) Exposure to ambient air particulate matter and non-alcoholic fatty liver disease. World J Gastroenterol 19(25):3951–3956. https://doi.org/10.3748/wjg.v19.i25.3951
Tenkanen L, Sjoblom T, Kalimo R, Alikoski T, Harma M (1997) Shift work, occupation and coronary heart disease over 6 years of follow-up in the Helsinki Heart Study. Scand J Work Environ Health 23(4):257–265. https://doi.org/10.5271/sjweh.218
Triantafyllou GA, Paschou SA, Mantzoros CS (2016) Leptin and hormones: energy homeostasis. Endocrinol Metab Clin North Am 45(3):633–645. https://doi.org/10.1016/j.ecl.2016.04.012
Tsai SF et al (2022) High-fat diet-induced increases in glucocorticoids contribute to the development of non-alcoholic fatty liver disease in mice. FASEB J 36(1):e22130. https://doi.org/10.1096/fj.202101570R
Wang H et al (2018) Association between bedtime and the prevalence of newly diagnosed non-alcoholic fatty liver disease in adults. Liver Int 38(12):2277–2286. https://doi.org/10.1111/liv.13896
Wang F et al (2019) Night shift work and abnormal liver function: Is non-alcohol fatty liver a necessary mediator? Occup Environ Med 76(2):83–89. https://doi.org/10.1136/oemed-2018-105273
Wang D et al (2021) Shift work disorder and related influential factors among shift workers in China. Sleep Med 81:451–456. https://doi.org/10.1016/j.sleep.2021.03.008
Woods CP, Hazlehurst JM, Tomlinson JW (2015) Glucocorticoids and non-alcoholic fatty liver disease. J Steroid Biochem Mol Biol 154:94–103. https://doi.org/10.1016/j.jsbmb.2015.07.020
Younossi ZM (2019) Non-alcoholic fatty liver disease—a global public health perspective. J Hepatol 70(3):531–544. https://doi.org/10.1016/j.jhep.2018.10.033
Younossi ZM, Corey KE, Lim JK (2021) AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: expert review. Gastroenterology 160(3):912–918. https://doi.org/10.1053/j.gastro.2020.11.051
Zhang X, Chen G, Xu F, Zhou K, Zhuang G (2016) Health-related quality of life and associated factors of frontline railway workers: a cross-sectional survey in the Ankang Area, Shaanxi Province, China. Int J Environ Res Public Health 13(12):1192. https://doi.org/10.3390/ijerph13121192
Zhang S et al (2020) Rotating night shift work and non-alcoholic fatty liver disease among steelworkers in China: a cross-sectional survey. Occup Environ Med 77(5):333–339. https://doi.org/10.1136/oemed-2019-106220
Zhang S et al (2021) Dietary patterns and risk of non-alcoholic fatty liver disease in adults: a prospective cohort study. Clin Nutr 40(10):5373–5382. https://doi.org/10.1016/j.clnu.2021.08.021
Zhao B et al (2021) Effect of frequency and pattern of night shift on hypertension risk in female nurses: a cross-sectional study. J Hypertens 39(6):1170–1176. https://doi.org/10.1097/hjh.0000000000002755
Acknowledgements
The authors wish to thank the participants for their valuable contributions to the current research.
Funding
This work was supported by the Natural Science Foundation of Tianjin (20JCZDJC00320).
Author information
Authors and Affiliations
Contributions
The study conception was designed by J.X., N.T., and X.Y. H.L. and S.N. collected the research data. J.X., Y.W., and Z.Y. conducted the statistical analysis and interpreted the results. J.X. drafted the manuscript. All authors have read and approved the final version of manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Patient consent
Not required.
Standards of reporting
We utilized the STROBE Checklist to adhere to reporting guidelines for observational studies.
Ethics approval
This study was approved by the ethical committee of the coordinating center of Tianjin Medical University (Protocol No. TMUhMEC2022007).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Xu, J., Ni, S., Wang, Y. et al. Shift work and nonalcoholic fatty liver disease incidence among Chinese rail workers: a 4-year longitudinal cohort study. Int Arch Occup Environ Health 96, 179–190 (2023). https://doi.org/10.1007/s00420-022-01913-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-022-01913-0